OTTAWA –
Nearly two and a half years since the start of the COVID-19 pandemic, the staffing conundrum initially driven by high infection rates has turned into an acute labor challenge.
Herb Emery, the Vaughan Chair in Regional Economics at the University of New Brunswick, said that when it comes to staffing shortages, the pandemic is “like the straw that broke the camel’s back.”
“These emerging deficits have been there for decades,” Emery said. “So nobody should be surprised that we’re short of doctors, that we’re short of nurses.”
In recent weeks, hospitals across the country have taken drastic measures to deal with staff shortages, including temporarily closing emergency departments.
Labor shortages are not unique to health care. National Statistics Canada says about one million jobs are vacant. But the most striking are the deficits in health care.
Statistics Canada reported that health care vacancies in the first quarter of this year were almost double the number of two years ago. Nursing and aides were among the top ten occupations with the largest increase in job vacancies during this period.
Emery says the health care shortage is a result of policies put in place in the 1980s and 1990s that were aimed at reducing health care costs. Doctors, who are remunerated on a fee-for-service structure, were identified as a major driver of increased health care costs, and policies were put in place to limit the supply of doctors, he said.
The Canadian Institute for Health Information said in a 2002 report that policies such as reduced medical school enrollment and restrictions on international medical graduates contributed to a lower influx of new doctors.
As for nurses, Emery said the stress of the pandemic and increased workloads have led to high rates of retirement and leaving the profession, and enrollment in nursing schools has not been high enough to compensate for the outflow of nurses. .
Some experts say one solution may be to move to a team approach to care that ensures health professionals are working at their skill level. This would mean relieving doctors of tasks that nurses or pharmacists could take on, while nurses only do work that requires nursing training.
Armine Yalnizian, an economist and Atkinson Fellow on the Future of Workforce, is calling on provinces to develop a plan to address today’s health care challenges, including outlining a health human resources strategy.
“The most expensive parts of the system are overworked to do things they shouldn’t be doing, like cleaning rooms or moving patients down the hall on a gurney,” Yalnizian said.
The idea of changing the scope of practice of healthcare workers is far from new. In 2002, the Royal Commission on the Future of Health Care in Canada, also known as the Romanov Report, highlighted the need for this change in practice.
“Changes in the way health services are delivered, particularly with the increasing emphasis on collaborative teams and networks of health care providers, mean that traditional scopes of practice must also change,” the report said. “This implies new roles for nurses, family physicians, pharmacists, case managers and a host of new and emerging health professions.”
Emery said the fee-for-service physician compensation structure is a barrier to moving to team-based care.
“What discourages a 1/8 fee for a 3/8 service is a nurse doing some of the tasks that they’re qualified and can do quite well because the doctor in whose office they work can’t charge for this,” Emery said.
The shift to team-based care will also require restructuring the collective bargaining agreements, he said, that dictate “who does what” in hospitals.
“There are things that can be done, but they are politically contentious,” Emery said.
In Ontario, the provincial government has said it is considering privatization of health care as a solution to the challenges facing hospitals. The proposal led to significant backlash from opposition politicians as well as advocates.
However, Emery says that privatization in this context is about providing services, not how services are paid for.
“I think it’s really about changing where care is delivered, from places that tend to have stricter rules about who can do what to whom and on what basis, to a place where there’s more potential to have such scope of practice, team-based care, and generally get more patients seen with the same number of doctors and nurses.”
Yalnizian says the health care system has been dealing with low staffing levels for too long due to a lack of funding.
“It’s not just a lack of preparation for the future. We are absolutely committed to not spending money,” she said.
However, Emery warns that more funding will not solve the underlying problem, namely how workers are allocated within the system.
Failure to address these issues, he says, is what led to these health care shortages and strains in the first place.
“The frustrating part is that now that it’s been hit, we’re kind of wringing our hands saying, ‘okay, what do we do,’ because there’s no easy solution in the short term,” Emery said.
This report by The Canadian Press was first published on September 5, 2022.